Probenecid Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Gout

Initial : 250 mg orally every 12 hours for 1 week.
Maintenance: 500 mg orally every 12 hours.
The dose may be further increased on a monthly basis in 500 mg increments until serum uric acid levels have normalized. The maximum daily dose should not exceed 2 g.

Due to an initial increased risk of gouty attacks, concomitant prophylactic colchicine or a nonsteroidal anti-inflammatory agent is recommended during the first 3 to 6 months of probenecid therapy. In addition, patients should be instructed to drink approximately two liters of fluid per day to prevent the formation of uric acid stones.

Usual Adult Dose for Adjunct to Antibiotic Therapy

1 g orally one time for patients treated for uncomplicated gonorrhea with ampicillin or cefuroxime.
500 mg orally 4 times a day for 10 to 14 days for patients treated for neurosyphilis with penicillin G procaine.

Usual Pediatric Dose for Adjunct to Antibiotic Therapy

2 to 14 years:
Initial: 25 mg/kg orally as a single dose or 0.7 g/m2 orally as a single dose to prolong penicillin levels.
Maintenance: 10 mg/kg/day orally or 1.2 g/m2/day orally administered as equally divided doses 4 times a day.

Renal Dose Adjustments

Probenecid is not recommended in patients with severe renal dysfunction.

Liver Dose Adjustments

Data not available

Dose Adjustments

Patients receiving multiple dosage antibiotic therapy may use 500 mg orally 4 times a day. Patients receiving single dosage antibiotic therapy may use 1 g concomitantly as a single dose.

Precautions

Probenecid is contraindicated in patients who are overproducers of uric acid (that is, 24-hour urinary uric acid excretion of greater than 750 mg). In addition, probenecid is not recommended for use in patients with uric acid kidney stones or blood dyscrasias. Therapy with probenecid is contraindicated in patients with an active gouty attack. It can be started after gouty attack has subsided. The use of salicylates is contraindicated in patients taking probenecid because they antagonize the uricosuric effect of probenecid. Probenecid is contraindicated in patients under two years of age.

Rarely, severe allergic reactions and anaphylaxis have been reported. Most of these have been reported to occur within several hours after readministration following prior usage of probenecid. Probenecid should be discontinued if hypersensitivity reactions are observed.

Exacerbation of gout following probenecid therapy may occur; in such cases colchicine or other appropriate therapy is advisable.

Hematuria, renal colic, costovertebral pain, and formation of uric acid stones reported with the use of probenecid in gouty patients may be prevented by alkalization of the urine and a liberal fluid intake (2 liters/day). In these cases when alkali is administered, the acid-base balance of the patient should be monitored.

Probenecid should be used with caution in patients with a history of peptic ulcer.

Probenecid therapy has been used in patients with some renal impairment, but dosage requirements may be increased. Probenecid may not be effective in chronic renal insufficiency particularly when the glomerular filtration rate is less than 30 mL/min.

A reducing substance may appear in the urine of patients receiving probenecid therapy. This disappears with discontinuance of treatment. Suspected glycosuria should be confirmed with a test specific for glucose.

Dialysis

Data not available

Other Comments

Due to an initial risk of gouty attacks, concomitant prophylactic colchicine or a NSAID is recommended during the first 3 to 6 months of probenecid therapy. Alkalization of the urine is recommended until serum urate level returns to normal. The addition of sodium bicarbonate (3 to 7.5 g/day) or potassium citrate (7.5 g/day) will help maintain an alkaline urine.

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